A recently published study suggested there were “socioeconomic status (SES) inequities in the cardiovascular protection associated with the traditional Mediterranean Diet.” Simply put, the Mediterranean diet reduced cardiovascular risk but only in higher socioeconomic groups. The best benefits came among those who were well educated and had better incomes. It also suggested that the better health outcome of this richer and more educated bunch happened because they were able to buy higher quality, healthier food.

This may make for great headlines: low-income, less educated people are victims of a cruel society that keeps them powerless and less healthy. It also bugs me to no end. I have spent most of my career working with primarily low- and moderate-income populations. My patients read a headline that says only the wealthy and educated can benefit from a Mediterranean diet and conclude things are just stacked against them because they aren’t wealthy or upper-income people and may never be.

What’s in The Study but Not the Headlines:

Whenever I see conclusions like these I know it’s time to dig in a little deeper. There are other conclusions, perhaps more realistic ones, that could be drawn from this study, even if they wouldn’t grab headlines.

All studies have weakness and limitations. Many never make it into the press releases and news articles, however, and that just adds to all the nutrition confusion out there. This study’s authors acknowledged some of the study’s weaknesses, but there were others that weren’t considered.

The authors acknowledged the study’s somewhat short duration, only 4.3 years of follow-up. Fair enough — it is what it is.

They noted that dietary information was self-reported and taken only once and only at baseline. A lot can change over 4 years that could impact the value of the study’s findings and conclusions.

Average age of the subjects was mid-50’s. There is no record of their dietary history up to this point. It’s one of the problems with this type of research – current dietary pattern doesn’t indicate your lifetime dietary history, when many of your health risks were likely determined.

Differences in health outcomes were attributed to dietary disparities. That’s a leap. The outcomes may have had more to do with health care disparities throughout the years prior to the study, rather than whether or not they ate a green vegetable the day before they were interviewed.

The study noted that higher SES groups “are more likely to get in line with dietary recommendations”. Very likely, but such groups may also be more likely to afford and seek medical attention, take prescribed medication, follow physician recommendations, and make other positive lifestyle modifications. This is a huge piece of the puzzle.

Rich and Educated Didn’t Always Do the Smart Thing

Higher income participants actually ate a narrower variety of vegetables than the lower income group and practiced LESS healthful cooking methods for beef, such as grilling and frying. Does that mean also that eating fewer types of vegetables and doing more frying and grilling of beef is “linked” to a better outcome? Not likely, although, to be fair and balanced, that’s what the data show, and it’s just as statistically accurate to make such a statement from these data. This is why describing a behavior as “linked” or “associated” to an outcome doesn’t always tell us much and should certainly never be considered equivalent to “cause-and-effect.”

Observational studies make it easy to cherry-pick what you want to conclude. All they are really designed to do however, is generate a hypothesis, not a conclusion.

We should be empowering and motivating lower-income people, not treating them as victims. I don’t have the luxury of telling my low-income patients sorry, but eating better and being healthier are a rich man’s game. Hello? They need and deserve help, motivation, and sound nutrition advice, not to hear their health is at risk because they didn’t go to college or make a lot of money.

A Healthy, Economical Mediterranean Diet

Your Mediterranean diet doesn’t have to be populated with lobster and shrimp and washed down with an expensive chardonnay. For the rest of us, more reasonable options are the way to go, and they can be just as tasty and healthful. After all, the original Mediterranean diet wasn’t about indulgence, it was about making the best from what was available.

Try these tips for eating a delicious Mediterranean diet. They’re budget-friendly but they’re smart for any budget:

Canned salmon – a treasure. It’s my own go-to for omega-3 fats. Surprise: it’s almost always wild, but without the wild price of the fresh stuff. The edible bones are loaded with calcium and vitamin D, too.

Beans, any kind, canned, fresh, or dry: Hummus anyone? Canned kidney or garbanzo beans are great topped with some pasta sauce.

Eat in the “C-suite”. Super-nutritious affordable fave veggies: carrots, cabbage, collards, cauliflower, celery. All great choices any time of year.

Frozen: peas, green beans are awesome and just as nutritious as fresh, with no prep or waste.

Fruits: eat the best of each season. It’ll taste better and be more affordable. Let it be your sweet treat instead of junk sweets.

Extra-virgin Olive oil: You only need a little. Buy what you can afford and use it where you’ll really taste it — on salads, bread, even on hummus.

Dessert, anyone? Try Greek yogurt with fruit, nuts, and a teaspoon of honey. Great for protein when it’s a meatless meal, too.

Nuts in bags, not jars. You get more for the money. An ounce a day is enough for benefits.

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Dr. Keith Ayoob

Keith is an Associate Clinical Professor at the Albert Einstein College of Medicine in New York City where he has maintained a clinical practice for over 30 years, specializing in obesity, child nutrition, and family dynamics. Much of his work also focuses on motivational counseling.